Flip a coin.

You stand a better chance of getting "heads" than U.S. children have of receiving high-quality health care—that is, the right care, delivered when they need it. Moreover, children get lower-quality care than adults.

This stunning news about the state of children’s health care, published this week in the New England Journal of Medicine, comes hard on the heels of President Bush’s veto of the bipartisan State Children’s Health Insurance Program (SCHIP). The SCHIP debate has focused national attention on kids’ health care coverage. That’s a good thing. More than 9 million American kids live each day without any health insurance coverage—which virtually guarantees that they’re not getting the kind of health care they need.

But the new study should put America on notice that the health care debate cannot stop at cost and coverage. What happens once you get inside the doctors’ office—the quality of the actual care you receive—is a topic ripe for discussion.

The New England Journal study, conducted by the RAND Corporation, Seattle Children’s Hospital and the University of Washington School of Medicine, and supported by the Robert Wood Johnson Foundation, is part of a groundbreaking effort to show what’s happening with our health care in America. For this latest study, researchers examined 175 quality measures for things like screening, diagnosis, treatment and follow-up care for common children’s health issues. They reviewed the medical records of 1,500 children to see how their care compared to these quality indicators. They found that, on average, children received only 46.5 percent of the indicated care. By comparison, a similar study of adults found they received recommended care 54.9 percent of the time—only slightly better, but not by much. These percentages are deplorable for a country that spends more on health care per capita than any nation on the planet.

What is this new data telling us? First, while health care coverage for children is vital, it is not enough. In the new study, nearly all of the children in the analysis had coverage, and more than 8 in 10 had private insurance—and they still received poor quality care.

Second, we’re better at treating acute medical problems than managing chronic disease. For instance, the researchers found that children receive the recommended treatment for the common cold (an acute condition) 92 percent of the time, but children with asthma received the right care just 46 percent of the time. Overall, the study found that children received the right care 68 percent of the time for acute problems, 53 percent of the time for chronic conditions, and 41 percent of the time for preventive care.

Third, some of our most pressing public health battles aren’t being fought on the front lines. Consider obesity. More than 33 percent of all children and adolescents are overweight or obese. That works out to nearly 13 million young children and teenagers. They will grow up to be among the 144 million men and women considered overweight or obese in the United States—more than half the population. Yet according to this study, only 31 percent of 3 to 6-year-olds, and 15 percent of adolescents, have their weight monitored, a critical step to forestalling later problems such as hypertension and diabetes.

Finally, the new data reaffirms something we’ve always known about health care: You get what you pay for. We have a system that has traditionally paid providers for doing things and showing up—performing procedures or conducting tests and conducting visits—but not necessarily for doing the right things, such as helping prevent or manage diabetes, asthma and other chronic illnesses.

The new study clearly shows that it is not enough to worry about covering children. We must also ask tough questions about the actual quality of care they receive. When it comes to our kids, we have to do better than a coin toss.